Taak 5 Borderline
Rosenthal Borderline personality disorder and emotional responding: A review
of the research literature
- Although problems with emotional functioning are considered central to borderline
personality disorder (BPD), it is only recently that studies have begun utilizing
laboratory biobehavioral measures (including neuroimaging and psychophysiological
measures) to examine emotional responding in BPD. The application of basic science
methodologies used in a systematic program of research to investigate clinically
relevant phenomena, often called translational research, holds much promise in
advancing the assessment and treatment of BPD. In this paper, we begin with an
overview of the research on self-reported emotional responding in BPD. Next, we
outline the advantages that translational research has over traditional self-report
methodology in furthering an understanding of emotional responding in BPD, and
review the extant laboratory studies of emotional responding in BPD. Finally,
problems commonly encountered when conducting translational research on emotion
in BPD are outlined, and solutions to these problems are offered.
Self-report studies
- BPD report greater lability in anger and anxiety compared to individuals with other
personality disorders. BPD reported greater variability in mood from morning to
evening, and less consistency in mood from one day to the next, compared to
individuals with major depression and those without psychiatric disorders. BPD report
higher affect intensity/reactivity than individuals with other personality disorders.
BPD reported higher levels of negative affect intensity/reactivity but similar levels of
positive affect intensity/reactivity. BPD reported more frequent and higher levels of
“aversive internal tension” that increased more quickly and lasted for a longer period
of time than in healthy controls.
Translational research: an overview
- the focus of this approach lies simply in the translation of basic findings into clinical
applications.
- translational research is less related to the translation of a particular basic finding into
clinical practice and more related to the development of a systematic research plan
based upon a well-defined clinical question. A translational research approach
includes the use of laboratory methods for assessing basic processes relevant to
specified clinical phenomena. As a program of research begins to produce a better
understanding of basic processes, the focus on clinical applications becomes more
evident, including an increased focus on ecological and external validity
translational research: emotional responding in BPD
Behavioural studies
- BPD participants had levels of facial emotional expressivity comparable to
- depressed participants. Both clinical groups demonstrated significantly less facial
emotional expressivity than controls when viewing a negative movie clip. With
respect to expressions of discrete emotions, the control group displayed significantly
more expressions of contempt than the BPD or depressed groups. However, there were
no differences in emotional expressiveness between any groups for sadness, anger,
disgust, or fear expressions, indicating that individuals with BPD were not
characterized by significant differences in general emotional expressivity
psychophysiological studies
- measures such as skin conductance, facial electromyography, finger temperature, and
heart rate.
- increased arousal occurred in response to unpleasant stimuli
1
, - BPD participants had significantly lower skin conductance levels across all slide types
than healthy controls and APD participants. BPD participants reported less pleasant
emotional experiences while viewing pleasant and neutral slides than did control
participants.
- BPD participants viewing positive images reacted physiologically as though they were
experiencing negative affect
- BPD evidenced significantly larger startle responses and slower startle habituation
than controls
- the findings do not provide consistent support for elevated physiological responsivity
to emotionally evocative stimuli, in contrast to theoretical models (Linehan, 1993) and
studies using self-report methodologies, both of which suggest that heightened affect
intensity/reactivity is a key characteristic of BPD. Second, most studies provide some
evidence of greater emotional reactivity in BPD across certain indices of emotional
responding but not others, suggesting the possibility ofmixed or discordant emotional
responding among individuals with BPD. For example, in some cases, BPD
participants evidenced heightened arousal on some psychophysiological measures but
not on others, and in other cases, they reported heightened arousal while exhibiting the
same or lower levels of physiological arousal (compared to controls). Third,
individuals with BPD may be more likely to dissociate during the emotionally
evocative laboratory-based paradigms, attenuating the impact of their negative
affective experiences. In our review, only the Ebner-Priemer et al. study directly
corroborated this possibility; however, Schmahl et al.also reported a statistical trend
consistent with this possibility. Given that dissociation under stress is a diagnostic
criterion for BPD and that the intercorrelations between a history of traumatic stress,
BPD, and dissociation are high, these results suggest the possibility that individual
differences in dissociation among BPD individuals may help to explain the apparent
discrepancies in the patterns of findings across studies. A fourth explanation for the
mixed findings in this area is that, because BPD is a disorder with considerable
symptom heterogeneity, differences in findings across studies may reflect differences
in the BPD symptom profiles across samples . The complications for data synthesis
and integration introduced by the symptom heterogeneity in BPD is compounded
further by the use of small sample sizes and associated lack of power to detect
statistical differences or obtain stable effect size estimates.
Common problems and possible solutions in translational research on emotion in BPD
- it is a challenge to conduct laboratory-based research with a severely distressed and
often suicidal population
- psychotropic medication use can confound study variables associated with emotional
responding.
- when different methods produce discrepant results, several interpretations are possible.
The first and most parsimonious interpretation is measurement error (i.e., the
possibility that one or more method is unreliable). Alternatively, the methods could
differ in the precise construct they measure
conclusions and implications
- Whereas studies using self-report methods consistently find that individuals with BPD
report being more emotionally intense, having greater negative affective responses to
emotionally evocative stimuli, and experiencing greater affective instability than
controls, results are mixed across studies using behavioral and psychophysiological
indices of emotional responding. Both subjective emotional ratings and HR
decelerations in response to pleasant stimuli suggest that individuals with BPD may
have greater negative emotional reactions to pleasant stimuli. Further, there is some
2
Rosenthal Borderline personality disorder and emotional responding: A review
of the research literature
- Although problems with emotional functioning are considered central to borderline
personality disorder (BPD), it is only recently that studies have begun utilizing
laboratory biobehavioral measures (including neuroimaging and psychophysiological
measures) to examine emotional responding in BPD. The application of basic science
methodologies used in a systematic program of research to investigate clinically
relevant phenomena, often called translational research, holds much promise in
advancing the assessment and treatment of BPD. In this paper, we begin with an
overview of the research on self-reported emotional responding in BPD. Next, we
outline the advantages that translational research has over traditional self-report
methodology in furthering an understanding of emotional responding in BPD, and
review the extant laboratory studies of emotional responding in BPD. Finally,
problems commonly encountered when conducting translational research on emotion
in BPD are outlined, and solutions to these problems are offered.
Self-report studies
- BPD report greater lability in anger and anxiety compared to individuals with other
personality disorders. BPD reported greater variability in mood from morning to
evening, and less consistency in mood from one day to the next, compared to
individuals with major depression and those without psychiatric disorders. BPD report
higher affect intensity/reactivity than individuals with other personality disorders.
BPD reported higher levels of negative affect intensity/reactivity but similar levels of
positive affect intensity/reactivity. BPD reported more frequent and higher levels of
“aversive internal tension” that increased more quickly and lasted for a longer period
of time than in healthy controls.
Translational research: an overview
- the focus of this approach lies simply in the translation of basic findings into clinical
applications.
- translational research is less related to the translation of a particular basic finding into
clinical practice and more related to the development of a systematic research plan
based upon a well-defined clinical question. A translational research approach
includes the use of laboratory methods for assessing basic processes relevant to
specified clinical phenomena. As a program of research begins to produce a better
understanding of basic processes, the focus on clinical applications becomes more
evident, including an increased focus on ecological and external validity
translational research: emotional responding in BPD
Behavioural studies
- BPD participants had levels of facial emotional expressivity comparable to
- depressed participants. Both clinical groups demonstrated significantly less facial
emotional expressivity than controls when viewing a negative movie clip. With
respect to expressions of discrete emotions, the control group displayed significantly
more expressions of contempt than the BPD or depressed groups. However, there were
no differences in emotional expressiveness between any groups for sadness, anger,
disgust, or fear expressions, indicating that individuals with BPD were not
characterized by significant differences in general emotional expressivity
psychophysiological studies
- measures such as skin conductance, facial electromyography, finger temperature, and
heart rate.
- increased arousal occurred in response to unpleasant stimuli
1
, - BPD participants had significantly lower skin conductance levels across all slide types
than healthy controls and APD participants. BPD participants reported less pleasant
emotional experiences while viewing pleasant and neutral slides than did control
participants.
- BPD participants viewing positive images reacted physiologically as though they were
experiencing negative affect
- BPD evidenced significantly larger startle responses and slower startle habituation
than controls
- the findings do not provide consistent support for elevated physiological responsivity
to emotionally evocative stimuli, in contrast to theoretical models (Linehan, 1993) and
studies using self-report methodologies, both of which suggest that heightened affect
intensity/reactivity is a key characteristic of BPD. Second, most studies provide some
evidence of greater emotional reactivity in BPD across certain indices of emotional
responding but not others, suggesting the possibility ofmixed or discordant emotional
responding among individuals with BPD. For example, in some cases, BPD
participants evidenced heightened arousal on some psychophysiological measures but
not on others, and in other cases, they reported heightened arousal while exhibiting the
same or lower levels of physiological arousal (compared to controls). Third,
individuals with BPD may be more likely to dissociate during the emotionally
evocative laboratory-based paradigms, attenuating the impact of their negative
affective experiences. In our review, only the Ebner-Priemer et al. study directly
corroborated this possibility; however, Schmahl et al.also reported a statistical trend
consistent with this possibility. Given that dissociation under stress is a diagnostic
criterion for BPD and that the intercorrelations between a history of traumatic stress,
BPD, and dissociation are high, these results suggest the possibility that individual
differences in dissociation among BPD individuals may help to explain the apparent
discrepancies in the patterns of findings across studies. A fourth explanation for the
mixed findings in this area is that, because BPD is a disorder with considerable
symptom heterogeneity, differences in findings across studies may reflect differences
in the BPD symptom profiles across samples . The complications for data synthesis
and integration introduced by the symptom heterogeneity in BPD is compounded
further by the use of small sample sizes and associated lack of power to detect
statistical differences or obtain stable effect size estimates.
Common problems and possible solutions in translational research on emotion in BPD
- it is a challenge to conduct laboratory-based research with a severely distressed and
often suicidal population
- psychotropic medication use can confound study variables associated with emotional
responding.
- when different methods produce discrepant results, several interpretations are possible.
The first and most parsimonious interpretation is measurement error (i.e., the
possibility that one or more method is unreliable). Alternatively, the methods could
differ in the precise construct they measure
conclusions and implications
- Whereas studies using self-report methods consistently find that individuals with BPD
report being more emotionally intense, having greater negative affective responses to
emotionally evocative stimuli, and experiencing greater affective instability than
controls, results are mixed across studies using behavioral and psychophysiological
indices of emotional responding. Both subjective emotional ratings and HR
decelerations in response to pleasant stimuli suggest that individuals with BPD may
have greater negative emotional reactions to pleasant stimuli. Further, there is some
2
